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Operative and short-term oncologic outcomes of laparoscopic versus open liver resection for colorectal liver metastases located in the posterosuperior liver: a propensity score matching analysis

Abstract

Background

Laparoscopic resection (LLR) of colorectal liver metastases (CRLM) located in the posterosuperior liver (segments 4a, 7, and 8) is challenging but has become more practical recently due to progress in operative techniques. We aimed to compare tumor-specific, perioperative, and short-term oncological outcomes after LLR and open liver resection (OLR) for CRLM.

Methods

Patients who underwent curative resection of CRLM with at least 1 tumor in the posterosuperior liver during 2012–2015 were analyzed. Tumor-specific factors associated with the adoption of LLR were analyzed by logistic regression model. One-to-one propensity score matching was used to match baseline characteristics between patients with LLR and OLR.

Results

The original cohort included 30 patients with LLR and 239 with OLR. Median follow-up time was 23.8 months. Logistic regression analysis showed that multiple, diameter ≥30 mm, deep location, and closeness to major vessels were associated with OLR. None of the 24 patients with none or one of these factors were converted from LLR to OLR. After matching, 29 patients with LLR and 29 with OLR were analyzed. The 2 groups had similar preoperative factors. The LLR and OLR groups did not differ with respect to operative time, intraoperative bleeding, incidence of blood transfusion, surgical margin positivity, incidence of postoperative complications, and unplanned readmission within 45 days. Median length of postoperative hospital stay was significantly shorter for LLR versus OLR (4 days [1–12] vs. 5 days [4–18]; p = 0.0003). Median recurrence-free survival was similar for patients who underwent LLR versus OLR (10.6 months for LLR vs. 13.4 months for OLR; p = 0.87).

Conclusions

Compared to OLR, LLR of posterosuperior CRLM is associated with significantly shorter postoperative hospital stay but otherwise similar perioperative and short-term oncological outcomes. Tumor-specific factors associated with safe and routine LLR approach despite challenging location are superficial, solitary, and small (<30 mm) CRLM not associated with major vessels.

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References

  1. 1.

    Minagawa M, Makuuchi M, Torzilli G, Takayama T, Kawasaki S, Kosuge T, Yamamoto J, Imamura H (2000) Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg 231(4):487–499

  2. 2.

    Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230(3):309–318 (discussion 318–321)

  3. 3.

    Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D, Giacchetti S, Paule B, Kunstlinger F, Ghemard O, Levi F, Bismuth H (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 240(4):644–657 (discussion 657–648)

  4. 4.

    Andreou A, Aloia TA, Brouquet A, Dickson PV, Zimmitti G, Maru DM, Kopetz S, Loyer EM, Curley SA, Abdalla EK, Vauthey JN (2013) Margin status remains an important determinant of survival after surgical resection of colorectal liver metastases in the era of modern chemotherapy. Ann Surg 257(6):1079–1088. doi:10.1097/SLA.0b013e318283a4d1

  5. 5.

    Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61(2):69–90. doi:10.3322/caac.20107

  6. 6.

    Azagra JS, Goergen M, Gilbart E, Jacobs D (1996) Laparoscopic anatomical (hepatic) left lateral segmentectomy-technical aspects. Surg Endosc 10(7):758–761

  7. 7.

    Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2,804 patients. Ann Surg 250(5):831–841. doi:10.1097/SLA.0b013e3181b0c4df

  8. 8.

    Rao A, Rao G, Ahmed I (2012) Laparoscopic or open liver resection? Let systematic review decide it. Am J Surg 204(2):222–231. doi:10.1016/j.amjsurg.2011.08.013

  9. 9.

    Wakabayashi G, Cherqui D, Geller DA, Han HS, Kaneko H, Buell JF (2014) Laparoscopic hepatectomy is theoretically better than open hepatectomy: preparing for the 2nd international consensus conference on laparoscopic liver resection. J Hepatobiliary Pancreat Sci 21(10):723–731. doi:10.1002/jhbp.139

  10. 10.

    Allard MA, Cunha AS, Gayet B, Adam R, Goere D, Bachellier P, Azoulay D, Ayav A, Navarro F, Pessaux P (2015) Early and long-term oncological outcomes after laparoscopic resection for colorectal liver metastases: a propensity score-based analysis. Ann Surg 262(5):794–802. doi:10.1097/sla.0000000000001475

  11. 11.

    Beppu T, Wakabayashi G, Hasegawa K, Gotohda N, Mizuguchi T, Takahashi Y, Hirokawa F, Taniai N, Watanabe M, Katou M, Nagano H, Honda G, Baba H, Kokudo N, Konishi M, Hirata K, Yamamoto M, Uchiyama K, Uchida E, Kusachi S, Kubota K, Mori M, Takahashi K, Kikuchi K, Miyata H, Takahara T, Nakamura M, Kaneko H, Yamaue H, Miyazaki M, Takada T (2015) Long-term and perioperative outcomes of laparoscopic versus open liver resection for colorectal liver metastases with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci 22(10):711–720. doi:10.1002/jhbp.261

  12. 12.

    Hasegawa Y, Nitta H, Sasaki A, Takahara T, Itabashi H, Katagiri H, Otsuka K, Nishizuka S, Wakabayashi G (2015) Long-term outcomes of laparoscopic versus open liver resection for liver metastases from colorectal cancer: a comparative analysis of 168 consecutive cases at a single center. Surgery 157(6):1065–1072. doi:10.1016/j.surg.2015.01.017

  13. 13.

    Cipriani F, Rawashdeh M, Stanton L, Armstrong T, Takhar A, Pearce NW, Primrose J, Abu Hilal M (2016) Propensity score-based analysis of outcomes of laparoscopic versus open liver resection for colorectal metastases. Br J Surg 103(11):1504–1512. doi:10.1002/bjs.10211

  14. 14.

    Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schon MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261(4):619–629. doi:10.1097/sla.0000000000001184

  15. 15.

    Ishizawa T, Gumbs AA, Kokudo N, Gayet B (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256(6):959–964. doi:10.1097/SLA.0b013e31825ffed3

  16. 16.

    Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, Hasegawa Y, Katagiri T, Takagi C, Itano O, Kaneko H, Wakabayashi G (2014) A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci 21(10):745–753. doi:10.1002/jhbp.166

  17. 17.

    Ogiso S, Nomi T, Araki K, Conrad C, Hatano E, Uemoto S, Fuks D, Gayet B (2015) Laparoscopy-specific surgical concepts for hepatectomy based on the laparoscopic caudal view: a key to reboot surgeons’ minds. Ann Surg Oncol 22(Suppl 3):S327–S333. doi:10.1245/s10434-015-4661-6

  18. 18.

    Lee W, Han HS, Yoon YS, Cho JY, Choi Y, Shin HK (2014) Role of intercostal trocars on laparoscopic liver resection for tumors in segments 7 and 8. J Hepatobiliary Pancreat Sci 21(8):E65–E68. doi:10.1002/jhbp.123

  19. 19.

    Xiao L, Xiang LJ, Li JW, Chen J, Fan YD, Zheng SG (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma in posterosuperior segments. Surg Endosc 29(10):2994–3001. doi:10.1007/s00464-015-4214-x

  20. 20.

    Pawlik TM, Scoggins CR, Zorzi D, Abdalla EK, Andres A, Eng C, Curley SA, Loyer EM, Muratore A, Mentha G, Capussotti L, Vauthey JN (2005) Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 241(5):715–722 (discussion 722–714)

  21. 21.

    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

  22. 22.

    Brudvik KW, Mise Y, Conrad C, Zimmitti G, Aloia TA, Vauthey JN (2015) Definition of readmission in 3,041 patients undergoing hepatectomy. J Am Coll Surg 221(1):38–46. doi:10.1016/j.jamcollsurg.2015.01.063

  23. 23.

    Mise Y, Vauthey JN, Zimmitti G, Parker NH, Conrad C, Aloia TA, Lee JE, Fleming JB, Katz MH (2015) Ninety-day postoperative mortality is a legitimate measure of hepatopancreatobiliary surgical quality. Ann Surg 262(6):1071–1078. doi:10.1097/sla.0000000000001048

  24. 24.

    Aloia TA, Zorzi D, Abdalla EK, Vauthey JN (2005) Two-surgeon technique for hepatic parenchymal transection of the noncirrhotic liver using saline-linked cautery and ultrasonic dissection. Ann Surg 242(2):172–177

  25. 25.

    Day RW, Cleeland CS, Wang XS, Fielder S, Calhoun J, Conrad C, Vauthey JN, Gottumukkala V, Aloia TA (2015) Patient-reported outcomes accurately measure the value of an enhanced recovery program in liver surgery. J Am Coll Surg 221 (6):1023–1030. e1021–1022. doi:10.1016/j.jamcollsurg.2015.09.011

  26. 26.

    Ogiso S, Conrad C, Araki K, Nomi T, Anil Z, Gayet B (2015) Laparoscopic transabdominal with transdiaphragmatic access improves resection of difficult posterosuperior liver lesions. Ann Surg 262(2):358–365. doi:10.1097/sla.0000000000001015

  27. 27.

    Yamashita S, Loyer E, Kang HC, Aloia TA, Chun YS, Mehran RJ, Eng C, Lee JE, Vauthey JN, Conrad C (2016) Total transthoracic approach facilitates laparoscopic hepatic resection in patients with significant prior abdominal surgery. Ann Surg Oncol. doi:10.1245/s10434-016-5685-2

  28. 28.

    Schiffman SC, Kim KH, Tsung A, Marsh JW, Geller DA (2015) Laparoscopic versus open liver resection for metastatic colorectal cancer: a metaanalysis of 610 patients. Surgery 157(2):211–222. doi:10.1016/j.surg.2014.08.036

  29. 29.

    Lewin JW, O’Rourke NA, Chiow AK, Bryant R, Martin I, Nathanson LK, Cavallucci DJ (2016) Long-term survival in laparoscopic vs open resection for colorectal liver metastases: inverse probability of treatment weighting using propensity scores. HPB (Oxford) 18(2):183–191. doi:10.1016/j.hpb.2015.08.001

  30. 30.

    Xiang L, Xiao L, Li J, Chen J, Fan Y, Zheng S (2015) Safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma in the posterosuperior liver segments. World J Surg 39(5):1202–1209. doi:10.1007/s00268-015-2946-3

  31. 31.

    Lee W, Han HS, Yoon YS, Cho JY, Choi Y, Shin HK, Jang JY, Choi H, Jang JS, Kwon SU (2016) Comparison of laparoscopic liver resection for hepatocellular carcinoma located in the posterosuperior segments or anterolateral segments: a case-matched analysis. Surgery 160(5):1219–1226. doi:10.1016/j.surg.2016.05.009

  32. 32.

    Chiow AK, Lewin J, Manoharan B, Cavallucci D, Bryant R, O’Rourke N (2015) Intercostal and transthoracic trocars enable easier laparoscopic resection of dome liver lesions. HPB (Oxford) 17(4):299–303. doi:10.1111/hpb.12336

  33. 33.

    Ichida H, Ishizawa T, Tanaka M, Terasawa M, Watanabe G, Takeda Y, Matsuki R, Matsumura M, Hata T, Mise Y, Inoue Y, Takahashi Y, Saiura A (2016) Use of intercostal trocars for laparoscopic resection of subphrenic hepatic tumors. Surg Endosc. doi:10.1007/s00464-016-5107-3

  34. 34.

    Pessaux P, van den Broek MA, Wu T, Olde Damink SW, Piardi T, Dejong CH, Ntourakis D, van Dam RM (2013) Identification and validation of risk factors for postoperative infectious complications following hepatectomy. J Gastrointest Surg 17(11):1907–1916. doi:10.1007/s11605-013-2226-1

  35. 35.

    Uchiyama H, Harimoto N, Itoh S, Yoshizumi T, Ikegami T, Maehara Y (2016) Pleural effusion after hepatectomy for hepatocellular carcinoma: risk factor analyses and its impact on oncological outcomes. World J Surg. doi:10.1007/s00268-016-3826-1

  36. 36.

    Hallet J, Sa Cunha A, Adam R, Goere D, Bachellier P, Azoulay D, Ayav A, Gregoire E, Navarro F, Pessaux P (2016) Factors influencing recurrence following initial hepatectomy for colorectal liver metastases. Br J Surg 103(10):1366–1376. doi:10.1002/bjs.10191

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Acknowledgements

The University of Texas MD Anderson Cancer Center is supported in part by the NIH/NCI under Award Number P30CA016672.

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Correspondence to Claudius Conrad.

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Disclosure

Drs. Masayuki Okuno, Claire Goumard, Takashi Mizuno, Kiyohiko Omichi, Ching-Wei D. Tzeng, Yun Shin Chun, Thomas A. Aloia, Jason B. Fleming, Jeffrey E. Lee, Jean-Nicolas Vauthey, and Claudius Conrad have no conflicts of interest or financial ties to disclose.

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Okuno, M., Goumard, C., Mizuno, T. et al. Operative and short-term oncologic outcomes of laparoscopic versus open liver resection for colorectal liver metastases located in the posterosuperior liver: a propensity score matching analysis. Surg Endosc 32, 1776–1786 (2018). https://doi.org/10.1007/s00464-017-5861-x

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Keywords

  • Laparoscopic hepatectomy
  • Colorectal liver metastasis
  • Posterosuperior segment